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Individual

DR. ANGELA WILBERT SOUTHWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
206 RIVERGATE PKWY, GOODLETTSVILLE, TN 37072-2033
(615) 859-9994
Mailing address
105 DANWOOD CT, HENDERSONVILLE, TN 37075-6311
(910) 603-1090

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8834
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
15118461
TN
05
5902819
NC
01
90241
BCBS
NC
Enumeration date
01/18/2006
Last updated
03/13/2013
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